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PEDIATRICS Vol. 112 No. 4 October 2003, pp. 829-837

Healing Patterns in Anogenital Injuries: A Longitudinal Study of Injuries Associated With Sexual Abuse, Accidental Injuries, or Genital Surgery in the Preadolescent Child

Astrid Heppenstall-Heger, MD*, Gina McConnell, RN{ddagger}, Lynne Ticson, MD*, Lisa Guerra, MD*, Julie Lister, FNP{ddagger} and Toni Zaragoza, FNP{ddagger}

* Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California
{ddagger} LAC+USC Medical Center, Center for the Vulnerable Child, Los Angeles, California

Objective. To study healing patterns of anogenital trauma in prepubescent children.

Methods. A prospective 10-year study was conducted of 94 children who had anogenital trauma and were followed to healing and documented using a colposcope with 35-mm camera attachment.

Results. The 13 boys and 81 girls were referred with injuries as a result of sexual assault or anogenital trauma. Hymenal injuries occurred in 37 cases; 2 transections healed after surgery, and 15 persisted unchanged. Partial tears, hymenal abrasions, or hematomas healed completely or with minor nonspecific changes. Of the 47 injuries to the posterior fourchette, 22 abrasions, hematomas, or tears healed completely; 12 tears healed with vascular changes; 2 developed labial fusions; 10 lacerations required surgery; and 6 scarred and 4 healed with vascular changes. Only 2 of 39 cases of perihymenal trauma healed with vascular changes. All 17 cases of labial trauma healed completely. Anal trauma healed completely in 29 of 31 with scarring occurring in only 2 cases that required surgery.

Conclusions. Anogenital trauma heals quickly, often without residua. Of the 94 cases, there were diagnostic anatomic changes in the 15 cases of hymenal transections (2 other cases healed completely with surgical reconstruction), 6 cases after surgical repair of posterior fourchette, and 2 cases of anal scarring after surgery.

Key Words: sexual abuse • child abuse • sexual assault • genital injuries • anogenital injuries • accidental genital injuries • healing of anogenital injuries

Abbreviations: CVC, Center for the Vulnerable Child • PF, posterior fourchette • FN, fossa navicularis

Received for publication Aug 29, 2002; Accepted Jan 23, 2003.


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